Transection of oblique muscles during an enucleation

This is Richard Allen at the University of Iowa. This video demonstrates isolation and transection of the obliques and optic nerve during enucleation surgery. The 4 rectus muscles have already be disinserted from the globe. Attention is directed superior-medial where the superior oblique tendon will be identified. This is identified by sweeping from medial to lateral, superiorly. The oblique tendon is identified which is avascular and can be transected simply with Westcott scissors. Attention is then directed to the inferior oblique. I prefer to sweep medial to lateral in the inferior lateral quadrant. The oblique is identified which is muscular and should be cauterized prior to transection. This can be performed with bipolar cautery. Needle tip cautery can be used but one should be careful using this close to the globe especially in globes with tumor. After cautery the scissors can then be used to transect the muscle. Attention is then directed to the optic nerve which in this case is approach medially. The nerve is felt with the tips of the scissors. Once one is confidently around the nerve with the blades of the scissors the nerve can be transected. Posterior Tenon's is then released from the posterior surface of the globe. In this case the patient had a melanoma and a long optic nerve stump was not necessary.